• Fluoride for prevention of dental decay when prescribed by a primary care provider to children ages 17 and under, and when the water source is fluoride deficient (see page 44 for coverage of fluoride varnish). • Hearing tests as part of a newborn screening. • Immunizations as specified under “Covered immunizations” on page 65. • Intensive behavioral counseling for adults who are overweight or obese and have additional cardiovascular disease risk factors. • Certain statin prescription drugs to adults age 40 or older (statin prescription drugs that are listed as “Preventive” in the Tier column on the UMP Preferred Drug List [see “The UMP Preferred Drug List” section]). • One-time screening by ultrasound for abdominal aortic aneurysm for men ages 65-75 who have ever smoked. • Preventive vision acuity screening from birth through 18 years of age. • Preventive visits such as well-baby care and annual physical exams. • Routine screenings for adults. • Screening for hepatitis B for adolescents and adults at high risk and those who are pregnant. • Screening procedures, such as colonoscopy (see page 46 for coverage of colonoscopy performed to diagnose or treat disease or illness). If you have a screening and the provider diagnoses and treats a condition during the colonoscopy, services will be paid at the standard rate. Note: Prostate cancer screening (prostate-specific antigen [PSA testing]) is not covered under the preventive care benefit but is covered as a medical benefit (subject to your medical deductible and coinsurance). For more information, see page 46. ALERT! Follow-up visits or tests as a result of your preventive care visit are not covered under the preventive care benefit. If the plan normally covers the test or visit and it is medically necessary, it is covered under the medical benefit. Contact UMP Customer Service to ask if a medical service is covered as preventive. Contact WSRxS Customer Service for questions about preventive prescription drugs. The following specific services are covered as preventive: • Chlamydia and gonorrhea testing in sexually active women ages 24 and younger, and for women age 25 or older who are at increased risk for infection. • Counseling and screening for HIV, counseling and screening for interpersonal and domestic violence, and counseling for sexually transmitted infections. • Education and counseling regarding contraception. • Human Papillomavirus (HPV) testing for women age 30 or older, once every three years. For additional services covered as preventive, see the following benefits: “Family planning services,” “Mammogram and Digital Breast Tomosynthesis (DBT),” and “Obstetric and newborn care.” Covered immunizations You pay the standard rate for covered immunizations that are not considered preventive. 2024 UMP Select (PEBB) Certificate of Coverage 65